68例儿童胆脂瘤型中耳炎临床分析

Clinical analysis of treatment effect on patients of suppurative otitis media with cholesteatoma --Report of 68 cases

目的 :探讨儿童胆脂瘤型中耳炎的诊断与治疗经验。方法 :对 6 8例 (72耳 )儿童胆脂瘤型中耳炎的临床表现、手术治疗及其治疗效果进行分析。结果 :儿童胆脂瘤型中耳炎早期诊断有一定困难 ,且胆脂瘤的侵蚀性较强 ,及时行 CT检查十分必要。术中常发现砧骨长脚和镫骨上结构受破坏 ,面神经水平段最易发生骨管缺损 ;手术治疗以开放式乳突根治彻底清除病灶后可行鼓室成形术 ,对提高听力 ,防止病变复发有一定优势。结论 :在严格掌握手术适应证的原则下儿童胆脂瘤型中耳炎行开放式乳突根治术彻底清除病灶 ,加鼓室成形术是可行的。

Objective:To investigate the effect of surgery treatment on children with supprative otitis media and cholesteatoma.Method:Sixty eight children(72 ears) with suppurative otitis media and cholesteatoma were treated in our department from January 1995 to March 2001.There were 51 males and 16 females,ranging in age from 7 months to 13 years old.The diagnosis of cholesteatoma determined by CT scanning and surgery confirmed.The surgical procedure of mastoidectomy and tympanoplasty was completed in all cases (along mastoidectomy in 13 ears,mastoidectomy+tympanoplasty in 59 ears).Result:The cure rate was 93 1%(67/72)and recurrent rate 6 9%(5/72)with the period of follow\|up 1 to 7 years.The auditory improve 10~20dBHL in 29 ears(49 2%,29/59),20~30dBHL in 18 ears (30 5%,18/59),>30dBHL in 7 ears (11 9%,7/59),no improve in 5 ears (8 5%,5/59).Conclusion:The diagnosis of pediatric cholesteatoma is difficult often,and the cholesteatoma have more invasion in children.The canal wall down mastoidectomy+tympanoplasty were preferable technique in the treatment of pediatric suppurative otitis media and cholesteatoma.